Elementary_Camps_2016 - page 13

13
SUMMER CAMPREGISTRATION FORM
for children entering first through eighth grade
CHILD’S NAME: AGE:
DATE OF BIRTH: GENDER:
SCHOOL CURRENTLY ATTENDING:
CHILD’S ADDRESS:
PARENT’S NAME:
ADDRESS: HOME PHONE:
PARENT’S E-MAIL: CELL PHONE:
WORK ADDRESS: WORK PHONE:
PARENT’S NAME:
ADDRESS: HOME PHONE:
PARENT’S E-MAIL: CELL PHONE:
WORK ADDRESS: WORK PHONE:
CHILD’S PHYSICIAN’S NAME, ADDRESS: CHILD’S PHYSICIAN’S PHONE:
ANY MEDICATIONS, ALLERGIES, HEALTH LIMITATIONS:
PERSONS TO CONTACT IN AN EMERGENCY IF PARENTS CANNOT BE REACHED:
NAME: PHONE(S):
NAME: PHONE(S):
The Renaissance International School
5201 Park Boulevard, Piedmont, CA 94611 · Phone: (510) 328-1127· Web:www.TheRenaissanceSchool.org
To indicate your camp selections, please see next page!